In-Hospital Screening Increases Osteoporosis Detection Rate

Osteoporosis detection rates are higher when patients are screened in-hospital than when screened in ambulatory practice, according to results of a new study. The findings suggest that in-hospital osteoporosis screening can be an additional tool to improve the identification and management of osteoporosis.

“According to our knowledge, this is the first large study evaluating DEXA screening results in a hospitalized sub-population in comparison to an ambulatory group and demonstrating a higher detection rate of osteoporosis among the in-patient population,” the authors wrote.

The researchers conducted a retrospective study in which they evaluated data of baseline dual energy x-ray absorptiometry (DEXA) examinations from 6406 consecutive patients seen at University Hospital of Liège in Belgium.

To assess whether differences existed between the diagnosis rates of osteoporosis, patients were divided into 2 groups: those who received ambulatory care (n=4561) and those who were hospitalized (n=1845).

Among all the patients, 22.3% received a diagnosis of osteoporosis.

Patients who were hospitalized had significantly lower T-scores and higher rates of osteoporosis at the lumbar spine, femoral neck, and total hip evaluations individually, as well as at all 3 sites.

In-hospital screening yielded a higher percentage of scans positive for osteoporosis than ambulatory care screening (31.8% vs 18.5%; P < .001).

“This better detection rate in osteoporosis indicated that an in-hospital screening strategy could be an effective additional tool to improve osteoporosis screening and identification,” the authors wrote.

While the in-hospital screening targeted an older and predominantly male population with a higher fracture history, the authors noted that the difference in detection rate was not only because of older age and suggested that more numerous comorbidities deleterious for bone health exist among hospitalized patients.

According to results of the univariate analysis, risk factors for osteoporosis included age, fracture history, and low body mass index (for lumbar spine, total hip, and femoral neck), as well as corticotherapy (for lumbar spine and femoral neck) and male gender (lumbar spine).

Findings of the multivariate analysis showed that age, fracture history, low body mass index, and male increased osteoporosis risk.

“This underlines the necessity not only to screen women, but also to think about men,” the researchers concluded.

—Melinda Stevens

Reference:

Malaise O, Detroz M, Leroy M, Leonori L, Seidel L, Malaise MG. High detection rate of osteoporosis with screening of a general hospitalized population: a 6-year study in 6406 patients in a university hospital setting. BMC Musculoskelet Disord. 2020;21(1):90. doi:10.1186/s12891-020-3116-9.